Senior Specialist, Provider Contracts HP

Molina Healthcare
Cambridge, MA
**Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to financial and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of Value Based Contracts (VBCs) post execution, including but not limited to, data analysis and reporting that ensures VBCs fulfill APM provider payment and regulatory requirements related to state-mandated value-based programs. Supports Manager with contracting/re-contracting of VBCs, issue escalations and JOCs on exception. Synchronizes data among multiple systems when applicable and ensures adherence to business and system requirements of customers as it pertains to contracting and network management. **Job Duties** This role supports assigned contracts with VBC providers that result in high quality and cost-effective care. Maintains tracking system and publishes reports according to departmental procedures. Contracting/re-contracting of VBCs, issue escalations and Joint Operating Committees on exception. - Assists Manager and/or Director in the negotiation of medical group/IPA and hospital VBC contracting. - Serves as VBC regulatory data and reporting lead by developing and producing as required to engage with provider and facilitate VBC performance. - Supports VBC network throughout the state to include onboarding VBC providers and supporting JOC's. - Clearly and professionally communicates VBC contract terms to VBC providers. - Coordinates preparation and routing distribution of documents to complete the contracting process in a timely and thorough manner according to standardized processes. - Communicates proactively with other departments to ensure effective and efficient business results. - Trains and monitors newly hired Contract Specialist(s). - Participates in other VBC related special projects as directed. - Limited team travel once to twice annually. **Job Qualifications** **REQUIRED EDUCATION:** Bachelor's Degree or equivalent work experience in health care field including, but not limited to, provider's office, managed care, or other health care field. **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** - 4-6 years' previous experience in contracting with large specialty or multispecialty provider groups. - 1-3 Years Managed Care experience **PREFERRED EXPERIENCE** : Provider facing experience and knowledge of integrated delivery systems, hospitals and groups (specialty and ancillary) highly desirable. Experience generating financial reporting to meet regulatory requirements. Ohio based candidate desired; however, not required. Pay Range: $30.37 - $61.79 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Posted 2025-11-14

Recommended Jobs

RN Home Care Coordinator

Element Care
Lowell, MA

Job Description Job Description Great Life work Balance position with excellent benefits!  Participates as a member of the PACE Interdisciplinary Team in the planning, implementation and evaluati…

View Details
Posted 2025-11-14

Crew team member

McDonald's
Boston, MA

Full-Time and Part-Time positions available at the following rates: We are currently offering a starting rate of $16 and up with experience/hour for closing shifts. (Must be available on we…

View Details
Posted 2025-11-14

Veterinary Internist (Board Certified / Diplomate / Residency Trained) J616456

Swansea, MA

Are you a board-certified Veterinary Internist or a residency-trained Internal Medicine Specialist nearing completion of your program? If you're looking to join a growing and collaborative team, this…

View Details
Posted 2025-11-05

Sales Specialist, DSP

Confluent
Boston, MA

**Location:** East Coast Region, United States **Employment Type:** FullTime **Location Type:** Remote **Department** Sales **Compensation:** $181.5K - $213.3K - Offers Equity - Offers Commission…

View Details
Posted 2025-11-14

Technical Integration Architect

Mondo
Boston, MA

Apply now: Technical Integration Architect, Location is Hybrid (Boston, MA). The start date is ASAP for this 6-month contract position. Job Title: Technical Integration Architect Location-Type…

View Details
Posted 2025-09-10

Reimbursement Solutions Analyst

Cardinal Health
Boston, MA

Headquartered in Dublin, Ohio, Cardinal Health, Inc. (NYSE: CAH) is a global, integrated healthcare services and products company connecting patients, providers, payers, pharmacists and manufacturers …

View Details
Posted 2025-11-12

Senior Data Analyst

Cmtelematics
Cambridge, MA

Cambridge Mobile Telematics (CMT) is the world’s largest telematics service provider. Its mission is to make the world’s roads and drivers safer. The company’s AI-driven platform, DriveWell Fusion®, …

View Details
Posted 2025-09-12

US Insurance Lead Product Owner Underwriting

Manulife
Reading, MA

We are seeking a strategic and innovative Lead Product Owner to support our Underwriting team in transforming the life insurance purchase journey —from application through to policy issuance. This ro…

View Details
Posted 2025-11-15

Computational Biologist

Dana-Farber Cancer Institute
Boston, MA

The Dana-Farber Cancer Institute seeks an Computational Biologist, under Jaclyn LoPiccolo to work as a data scientist on the analysis of germline whole-genome sequencing data of lung cancer patients a…

View Details
Posted 2025-11-14

Manager/Engineer CAD Product Design Engineer

Nth Cycle
Burlington, MA

CAD Product Design Engineer – Burlington, MA Who We Are: Demand for critical minerals to power the energy transition is growing exponentially. Yet, we know mining deeper and broader, and …

View Details
Posted 2025-10-20